Project 2: Cardiometabolic Disease and Risk Factors Among Older Adults in Sub-Saharan Africa Cardiovascular disease (CVD) has become the leading cause of death globally as a result of epidemiologic, social, and economic transitions globally. These transitions are at a relatively early stage in Sub-Saharan Africa (SSA), with the countries under study at different stages and experiencing contrasting trajectories. The purpose of this project is to establish cohorts of persons aged 50 and over in rural South Africa, Ghana, and Tanzania and, in doing so, characterize the changing rates, causes, and consequences of cardiometabolic disorders among older people in African settings undergoing demographic transition. Reliable data on baseline levels of chronic cardiometabolic disease (CMD) such as CVD and diabetes in older ages are extremely limited in rural SSA but understanding the rate of change in CMD is critical for social and health policy planning. Effective follow-up of participants and collection of self-reported health status and clinic and hospital services as well as established biomarkers and verbal autopsies will lead to a comprehensive understanding of the complex biologic, behavioral, demographic, and socioeconomic factors causing increasing death and associated risk from cardiovascular and metabolic disorders. Our long term goal is to enrich the INDEPTH cohort studies systems in Ghana,.South Africa and Tanzania so they can be used to plan health and social services to identify high risk individuals who can benefit from simple interventions to reduce CMD morbidity and mortality. Our overall project objective is to establish a baseline of key traditional and novel CMD risk factors, assess trajectories of select risk factors, and test whether easily identified and modifiable risk factors predict future mortality in African populations 50 and over in diverse settings where infectious disease including HIV/AIDS is prominent. The specific aims of Project 2 are: 1. To compare baseline prevalence of risk factors and advanced CMD across 3 SSA communifies 2. To establish trajectories and patterns of change in traditional and novel CMD risk factors and established CVD 3. To develop models to assess the association between traditional and novel biologic risk factors, social and environmental risk factors, and CVD mortality in areas of differential HIV prevalence.